Determinants of rural-urban differences in health care provider visits among women of reproductive age in the United States

Abstract

Background Rural health disparities and access gaps may contribute to higher maternal and infant morbidity and mortality. Understanding and addressing access barriers for specialty women’s health services is important in mitigating risks for adverse childbirth events. The objective of this study was to investigate rural-urban differences in health care access for women of reproductive age by examining differences in past-year provider visit rates by provider type, and quantifying the contributing factors to these findings. Methods and findings Using a nationally-representative sample of reproductive age women (n = 37,026) from the Medical Expenditure Panel Survey (2010–2015) linked to the Area Health Resource File, rural-urban differences in past-year office visit rates with health care providers were examined. Blinder-Oaxaca decomposition analysis quantified the portion of disparities explained by individual- and county-level sociodemographic and provider supply characteristics. Overall, there were no rural-urban differences in past-year visits with women’s health providers collectively (65.0% vs 62.4%), however differences were observed by provider type. Rural women had lower past-year obstetrician-gynecologist (OB-GYN) visit rates than urban women (23.3% vs. 26.6%), and higher visit rates with family medicine physicians (24.3% vs. 20.9%) and nurse practitioners/physician assistants (NPs/PAs) (24.6% vs. 16.1%). Lower OB-GYN availability in rural versus urban counties (6.1 vs. 13.7 providers/100,000 population) explained most of the rural disadvantage in OB-GYN visit rates (83.8%), and much of the higher family physician (80.9%) and NP/PA (50.1%) visit rates. Other individual- and county-level characteristics had smaller effects on rural-urban differences. Conclusion Although there were no overall rural-urban differences in past-year visit rates, the lower OB-GYN availability in rural areas appears to affect the types of health care providers seen by women. Whether rural women are receiving adequate specialized women’s health care services, while seeing a different cadre of providers, warrants further investigation and has particular relevance for women experiencing high-risk pregnancies and deliveries.

COVID-19 and Sexual and Reproductive Health Care: Findings From Primary Care Providers Who Serve Adolescents

“…It will be important to apply a health equity lens to future research on provision of SRH services in the context of COVID-19 [ 40 ]. For example, examining implementation of telehealth by urbanicity could inform efforts to minimize disparities in access to SRH care for rural populations where clinic-based services are less available [ 41 , 42 ]. Additional research on adolescent sexual behavior and service receipt is also warranted to fully understand the impact of the pandemic on unintended pregnancies and STIs among young people, which remains an important outstanding question.…”

Monthly Trends in Access to Care and Mental Health Services by Household Income Level During the COVID-19 Pandemic, United States, April: December 2020

“… 11 , 13 , 26 Given our findings, access to specialty care might also differ by household income level. Moreover, considering that utilization of health care services and health status were associated with neighborhood-level socioeconomic characteristics or racial/ethnic composition, 27 supply of physician or specialty care medical professionals, 28 or area deprivation, 29 it would be worthwhile to examine the association between access to care during the pandemic with neighborhood-level characteristics.…”

Rural–Urban Differences in the Utilization of Hospital-Based Care for Women of Reproductive Age

“… 16 , 23 Broadly speaking, access to recommended care and preventive services in rural communities is often also constrained by factors such as a lower supply of health care providers, more limited service availability, and unique aspects of rural culture, such as patient knowledge about and perceived value of preventive care. 12 , 14–21 , 40 , 41 Barriers to preventive care increase the risks for women to develop chronic illness and complicate the ability to manage existing illness, hence driving care more toward the inpatient setting. 42…”